2025, Vol. 7, Issue 2, Part B

Introduction: Periprosthetic femoral fractures following total hip replacement (THR) present a complex challenge, particularly after prior failed fixation. Vancouver type B1 fractures, characterized by a stable femoral implant, are typically treated with open reduction and internal fixation (ORIF). However, management becomes more complex when fractures involve residual trochanteric fragments from prior surgeries.

Case Report: A 67-year-old woman sustained a right intertrochanteric femur fracture in September 2024, treated initially with proximal femoral nailing (PFN). The implant failed within two months, prompting conversion to a THR in December 2024 using a standard-length stem. Associated fracture fragments were not addressed during the THR. In May 2025, after a minor fall, she sustained a periprosthetic femoral fracture at the stem level, classified as Vancouver B1. Radiographs and CT confirmed a well-fixed implant. She underwent ORIF using a Greater Trochanteric Reconstruction (GTR) plate with proximal cerclage cables and distal bicortical screws. No infection was present. The patient demonstrates good functional recovery and is able to gradually bear weight after 6 weeks.

Discussion: This case highlights the elevated risk of periprosthetic fracture following conversion THR after failed PFN. The stable stem allowed for B1 classification, permitting ORIF without the need for stem revision. The use of a GTR plate provided stable fixation even in the presence of residual trochanteric fragments, facilitating early mobilization and successful fracture union.